1. Chapter 10: Healthcare Statistics
Health Information Management Technology: An Applied Approach Third Edition
Chapter 10: Healthcare Statistics

2. Descriptive Statistics
Most common type of statistics encountered by health information technician
Describe population

3. Types of Data Measurement Scales of measurement Nominal-level data
Ordinal-level data
Interval-level data
Ratio-level data

4. Scales of Measurement Nominal-level data Ordinal-level data
Groups or categories
Measures data by name
Groups are mutually exclusive
Example: race
Ordinal-level data
Some order
Order is meaningful – not number
Example: staging pressure ulcer

5. Scales of Measurement Interval-level data Ordered and continuous data
Zero point is arbitrarily established
Intervals between successive values are equal
Example: temperature

6. Scales of Measures Ratio-level data Highest level of measurement
Defined unit of measure
Real zero value
Intervals between successive values are equal
Example: length of stay

7. Discrete and Continuous Data
Discrete variables:
Nominal or ordinal data
Fall into categories
Example: Gender
Continuous variables
Interval or ratio data
Includes fractions
Can perform mathematically calculations

8. Ratios, Proportions, and Rates
Indicate number of times something happens
Examples: morbidity, mortality, and natality

9. Ratio
Quantities being compared may be completely independent or show part of whole
Independent
255 patients discharged alive, 15 died
Part of whole
15 patients died out of 270 discharges

10. Proportions Type of ratio Quantity is part of whole
Numerator is always included in denominator
2 patients have cancer / 2 patients with cancer + 8 without cancer = 0.2

11. Rates Used to measure event over time.
May be used in performance improvement studies
Number of cases occurring during a given time period / total cases or population at risk during the same time period

12. Ratio, Proportion, and Rates
Rounding
Policy should state 1 or 2 decimal points
Round up at 5 or higher

13. Measures of Central Tendency and Variability
Mean
Median
Mode
Variability
Range
Variance
Standard deviation

14. Frequency Distribution
Values a variable can take and number of observations for each value

15. Mean Arithmetic average of frequency distribution Disadvantages
Fractional values
Sensitive to extreme measures

16. Median Midpoint of a frequency distribution Advantages
Relatively easy to calculate
Based on whole distribution—not portion
Outliers do not influence it

17. Mode Most frequent observation Advantages Disadvantages
Easy to obtain and interpret
Not sensitive to extremes
Easy to communication and explain
Disadvantages
Not descriptive when mode does not occur often and there is a large number of observations
May be more than one mode
Does not provide information on entire distribution

18. Range
Difference between smallest and largest value

19. Graphic Display of Data
Presents large quantities of information
Purpose is to communicate information about data
Graph should
Display data
Allow user to think about meaning of data
Avoid distortion of data
Encourage user to make comparisons
Reveal data at several levels—broad overview to fine detail

20. Tables
Orderly arrangement of values that groups data into rows and columns

21. Characteristics of Tables
Self-explanatory
All sources should be specified
Headings for columns and rows should be specific and understandable
Row and column totals should have been checked for accuracy
Enter zero or dash rather than leave cell blank
Categories should be mutually exclusive and exhaustive

22. Data Alignment Text in table should be aligned at left
Heading may be centered
Numeric values should be right aligned
Decimals should be aligned

23. Charts and Graphics
Emphasize points and analyze and clarify relationships among variables
Principles
Distortion
Proportion and scale
Abbreviations
Color
Print

24. Bar Charts Displays data from one or more variables
Bars may be horizontal or vertical

25. Pie Chart
Slices of pie show proportional contribution of each part

26. Line Graph Display time trends X-axis shows unit of time
Y-axis shows variable being plotted
Line connecting series of points
Several sets of data can be presented on one graph
Different lines
Y-axis can be numbers or percent

27. All Graphs Should: Be easy to read Use proper scale
Complete and accurate title
Informative legend

28. Histogram
Displays frequency distribution

29. Histogram vs. Bar Graph Bar graph Histogram
Data falls into groups or categories
Categories are noncontinuous (discrete)
Can be in fractions
Histogram
Continuous variables
May be number or percent

30. Frequency Polygon Graph depicting frequency of continuous data
Line format
May have several frequency polygons on one graph

31. Hospital Statistics
Collect information on inpatient and outpatients on daily basis
Monitor volume of students

32. Standard Definitions Hospital inpatient Hospital newborn inpatient
Inpatient hospitalization
Inpatient admission
Inpatient discharge
Hospital outpatient

33. Inpatient Census Data
Census reports patient activity for a 24 hour reporting period
Inpatients admitted
Inpatients discharged
Intrahospital transfers
Take count at same time of data
Account for patients admitted and discharged on same day

34. Inpatient Service Day
Unit of measure for services received by one patient during a 24 hour period
Daily inpatient census is equal to number of inpatient service days for a single day
Compiled daily, weekly, monthly, and annually

35. Inpatient Bed Occupancy Rate
Also called percentage of occupancy
Percentage of official beds occupied by hospital inpatients for given period of time
Bed count
Bed count days
May be greater than 100%

36. Length of Stay Data Calculated for each patient after discharge
Calendar days from day of admission to discharge
Adjust calculations for hospitalizations that cross calendar months
Length of stay for patients admitted and discharged on same day is 1
Total length of stay

37. Hospital Death (Mortality Rate)
Based on number of patients discharged alive and dead from facility
Gross death rate
Proportion of all hospital discharges that ended in death
Net death rate
Adjust death rate which excludes patients who died within 48 hours of admission

38. Newborn Death Rate
Newborns are included in hospital’s gross and net death rate
Calculated separately
Includes only newborns born alive at the hospital

39. Fetal Death Rate
Death that occurs prior to fetus’s complete expulsion or extraction from mother in a hospital facility
Any length of pregnancy

40. Fetal Death Classifications
Early fetal death: less than 20 weeks or weight of 500 grams or less
Intermediate fetal death: at least 20 but less than 28 weeks or weight of between 501 and 1,000 grams
Late fetal death: 28 weeks or weight of more than 1,000 grams

41. Maternal Death Rate
Death of any woman from any cause related to, or aggravated by, pregnancy or its management, regardless of duration or site of the pregnancy
Does not include accidental or incidental causes
Types
Direct maternal death rate
Indirect material death rate

42. Autopsy Rates Examination of dead body to determine cause of death
Types of autopsies
Hospital inpatient autopsy
Hospital autopsy

43. Types of Autopsy Rates Gross autopsy rates Net autopsy rate
Removes coroner or medical examiner cases
Hospital autopsy rate
Includes
Bodies of inpatients who died in hospital excluding coroner or medical examiner
Bodies of other hospital patients including ambulatory care, home health, and former hospital patients who died elsewhere but whose body is made available for autopsy

44. Available for Autopsy Includes
Autopsy is performed by hospital pathologists or designated physician on body of patient treated at some point in the hospital
Report of autopsy is filed in health record and in hospital laboratory or pathology department
Tissue specimens maintained in hospital lab

45. Fetal Autopsy Rate Performed to determine cause of fetal loss
Performed on intermediate or late fetal deaths

46. Hospital Infection Rates
Hospital-acquired infection rates
May be calculated for unit or entire hospital
Postoperative infection rate
Clean surgical case
Surgical procedure
Surgical operation

47. Consultation Rate
Consultation is when two or more physicians collaborate on patients diagnosis or treatment

48. National Vital Statistics System
Collection and analysis of data related to: birth, death, marriage, divorce, fetal death, and induced terminations of pregnancy
Used as part of effort to preserve and improve health of population
National Vital Statistics System
Maintains official vital statistics of the United States
Part of National Center for Health Statistics

49. Vital Statistics Standard forms Model procedures Standard certificates
Minimum basic data set
Revise about every 10 years
Used in
Research
Epidemiology
Public health programs

50. Certificate of Live Birth
Collects information on child and parents
Collects information on pregnancy
Not part of official birth certificate

51. Death Certificate Used to compile causes of death Contains
Decedent information
Place of death information
Medical certification
Disposition information
Causes of death classified and coded by ICD-10

52. Report of Fetal Death Completed when pregnancy results in stillbirth
Contains
Information on parents
History of pregnancy
Cause of fetal death

53. Report of Induced Termination of Pregnancy
Records information on:
Place of induced termination
Type of termination procedures
Patient

54. Linked Birth and Infant Death Data Set
Explores relationships between infant death and risk factors
Service provided by NCHS

55. Population-Based Statistics
Based on mortality and morbidity rates
Can infer health of population
Birth rates and measures of infant mortality

56. Birth Rates and Measure of Infant Mortality
Live birth
Delivery of product of conception that shows any sign of life after complete removal from the mother
Crude birth rate

57. Infant Mortality Neonatal mortality rate Postneonatal mortality rate
Up to 28 days of life
Postneonatal mortality rate
28 days up to, but not including one year
Infant death rate
Under one year of age

58. Death (Mortality) Rates
Crude death rate
Measure of actual or observed mortality in a given population
Cause-specific death rate
Rate of death due to specified cause
May be calculated for entire population, age, gender, or race
Case fatality rate
Probability of death among diagnosed cases of a disease

59. Death (Mortality) Rates
Proportionate mortality ratio
Measure of mortality due to specific cause for a specific time period
Maternal mortality rate
Deaths associated with pregnancy for specific community for a specific period of time

60. Measures of Morbidity
Measures to describe presence of disease in community or specific location
Incidence rate
Frequency of disease in different populations
Prevalence rate
Proportion of persons in population who have particular disease at a specific point in time or over specified period of time

61. National Notifiable Diseases Surveillance System
Regular, frequent, and timely information on individuals cases is necessary to prevent and control disease
Council of State and Territorial Epidemiologists and CDC determine which diseases are reported
State reporting to CDC is optional

62. External Sources of Healthcare Data
Benchmarking
CDC Resources
Cancer Surveillance, Epidemiology, and End Results (SEER)
Fatal Accident Reporting (FARS)
Data 2010
Injury Data and Resources
Leading Causes of Death
Mortality
Natality

63. National Center for Health Statistics
Part of CDC
Examples of NVSS data
Birth
Mortality
Linked births/infant deaths

64. National Health Care Survey
National Ambulatory Medicare Care Survey
National Hospital Ambulatory Medical Care Survey
National Hospital Discharge Survey
National Survey of Ambulatory Surgery
National Home and Hospice Care Survey
National Nursing Home Survey

65. Agency for Healthcare Research and Quality
Agency of HHS
Mission
Improve outcomes and quality of healthcare
Strengthen quality measurement and improvement
Reduce costs of healthcare
Address patient safety and medical errors
Broaden access to effective services

66. Healthcare Cost and Utilization Project (HCUP)
AHRQ database
Used for benchmarking
Data collected by states data organizations, state hospital associations, private data organizations, and federal government

67. Internal Use of Statistics and Patient Data for Research
Data is turned into information for
Joint Commission standards
State licensing requirements
Evaluation of healthcare providers
Improve organizational performance

68. Introduction to the Institutional Review Board
Required of organizations that conduct research on human subjects
Committee that protects rights and welfare of research subjects
Functions as ethics committee
Evaluates risk versus benefits
Informed consent

69. Federal Regulation Requires Human Subjects to be Given:
Description of researching including purpose, timeframe of subject involvement, description of procedures to be followed, and what is experimental
Description of reasonably foreseeable risks or discomforts
Benefits to subject or others
Disclosure of any appropriate alternative procedures or treatment

70. Federal Regulation Requires Human Subjects to be Given:
Confidentiality of records
When risk is more than minimal, statement on compensation or medical treatment available if injury occurs
Who to contact for answers
Statement that participation is voluntary with no penalties for discontinuing participation

71. Privacy Considerations in Clinical and Biomedical Research
HIPAA Privacy Rule
Protected Health Information
Defines means by which human research subjects are informed of how health information will be used or disclosed
Rights to information
Protects privacy while allowing access to researchers

72. Privacy Rule Authorization
PHI to be used or disclosed
Who is authorized to use or disclose PHI
Who the covered entity may make the request use or disclosure
Description of purpose
Expiration date or event
Signature and date

73. Privacy Rule Authorization
Right to revoke authorization at anytime and must be provided with procedure to do so
If treatment, payment, enrollment, or eligibility of benefits are contingent on authorization and consequences for refusing to sign
Any potential risk that PHI will be redisclosed by recipient and no longer protected by Privacy rule

74. Data Interpretation Issues
Data can be misinterpreted
Errors in calculations
Errors in presentation of data

75. Misleading Presentation of Numbers
Decisions are made based on data
Making up data
Misinformation

76. Ignoring the Baseline
Comparing raw numbers without adjusting baseline

77. Selection Bias
Sample does not represent population

78. Graphical Misrepresentations
Graphs can be manipulated

79. Ethical Guidelines in Statistics
Data collection, calculation, display, and interpretation must be appropriate and accurate
Should follow rules of IRB
Use appropriate statistical methods and techniques

80. American Statistical Association’s Ethical Guidelines for Statistical Practice
Present findings and interpretation honestly and objectively
Avoid untrue, deceptive, or undocumented statements Disclose any financial or other interests that may affect, or appear to affect, their professional statements